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CDVD > Arrythmia > Flashcards

Arrythmia Flashcards

1
Q

What is ectopic beats?

A

-extra or skipped heartbeats
-they are common

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2
Q

What is the tx for ectopic beats?

A

Beta blockers

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3
Q

What is atrial fibrillation?

A

-irregular and often abnormally fast heart rate
-100+ beats per min

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4
Q

What can AF lead to?

A

Stroke
->blood may not be fully ejected so can cause clot

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5
Q

whatare the 2 types of AF tx?

A

Ventricular rate control or sinus rhythm control

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6
Q

What is ventricular rate control?

A

Using medications

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7
Q

What is sinus rhythm control?

A

Using cardioversion

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8
Q

What do you do if pt presents with life-threatening haemodynamic instablilty?

A

Emergency electrical cardioversion w/o delaying to achieve anticoagulation

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9
Q

What do you do if pt presents w/o life-threatening haemodynamic instablilty within < 48hr

A

Rate or rhythm control

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10
Q

What do you do if pt presents w/o life-threatening haemodynamic instablilty within > 48hr

A

Rate control

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11
Q

What is pharmacological cardioversion?

A

Flecainide or amiodarone

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12
Q

What should be started and ruled with electrical cardioversion?

A

start IV anticoagulation + rule out left atrial thrombus

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13
Q

What is 1st line of AF maintenance?

A

-rate control monotherapy
-standard BBlocker (x sotalol) OR RL CCB (Diltiazem or verapamil) or digoxin (predominantly sedentary pt with non-paroxysmal AF)

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14
Q

what is 2nd line of AF maintenance?

A

rate control with dual therapy (bblocker + digoxin or ditiliazem)

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15
Q

what is 3rd line of AF maintenance?

A

-rhythm control
-if >48hr risk of clotting so electrical cardioversion
-Pt needs to be anticoagulated for at least 3 weeks and given oral anticoagulation for 4 wks after

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16
Q

What drugs are used for post cardioversion tx?

how long to ant

A

SPAF
-sotalol
-propafenone
-amiodarone ( start 4wk before and continue for 12MT)
-flecainide

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17
Q

What is paroxysmal AF?

A

Intermittent episodes of AF that terminate within seven days either spontaneously or with intervention.

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18
Q

How to tx paroxysmal AF?

A

1) Standard beta blockers
2) SPAF

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19
Q

tx of episodes of paroxysmal AF?

A

pill in pocket
flecainide/propafenone PRN

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20
Q

How does stroke prevention work?

A

-Assess risk of stroke + need for thromboprphylaxis (warfarin) using CHA2DSC2-VASc
- Not needed if men = 0 women =1

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21
Q

what is CHA2DSC2-VASc?

A

C = congestive heart failure - 1
H = hypertension - 1
A2 = age 75+ - 2
D = diabetes - 1
S2 = stroke/TIA - 2
V = vascular disease - 1
A = age 65-74 - 1
Sc = sex female - 1

22
Q

+ more effective

what are the two tx of atrial flutter?

A

-rhythm or rate control
-more effective with cardioversion

23
Q

which meds are used to tx atrial flutter

A

Bblockers or RL CCB

24
Q

+symptoms

what is atrial flutter?

A

-abnormal heart rhythm (arrhythmia) which causes the upper chambers of your heart (atria) to beat too quickly
-symptoms = palpitations and feeling light-headed

25
Q

How is rhythm control used in atrial flutter?

A

1) Direct current cardioversion
2) Pharmacological cardioversion
3) catheter ablation (recurrent tx)

26
Q

What do you do if atrial flutter has lasted >48hr?

A

anticoagulation for 3wk

27
Q

What is paroxysmal supraventricular tachycardia?

A

-due to development of short circuit rhythm in the upper chamber of the heart
-results in a regular but rapid heartbeat that starts and stops abruptly
-normally tx not needed

28
Q

What is the tx for paroxysmal supraventricular tachycardia?

should terminate spontaneously on its own

A

1) reflux vagal stimulation
2) IV adenosine
3) IV verapamil

29
Q

What is the tx for reccurent paroxysmal supraventricular tachycardia?

A

recurrent - catheter ablation

30
Q

What is given to prevent future paroxysmal supraventricular tachycardia?

A

bblockers or RL CcB

31
Q

What is ventricular tachycardia?

A

-abnormal heart rhythm or arrhythmia
-occurs when the lower chamber of the heart beats too fast to pump and the body doesn’t receive enough oxygenated blood

32
Q

How do you tx pulseless ventricular tachycardia or ventricular fibrillation?

A

resuscitation

33
Q

How do you tx unstable sustained ventricular tachycardia?

A

-direct current cardioversion or IV amiodarone
-repeat current cardioversion of others x work

34
Q

How do you tx stable ventricular tachycardia?

A

1) IV amiodarone then direct current cardioversion
2) if x sustained bblocker

35
Q

What is the maintenance therapy for pt who are at high risk of cardiac arrest?
Pharm + nonpharm tx

A

1) implantable cardioverter defibrillator
2) + bblocker or amiodarone (in combination with bblocker)

36
Q

What is QT prolongation?

A

-extended interval between the heart contracting and relaxing
-increases risk of experiencing abnormal heart rhythms and sudden cardiac arrest
-can be present from birth, or it may develop later in life
-usually self-limiting** but can be recurrent
-can lead to impaired consciousness if not controlled VF to DEATH

37
Q

What causes QT prolongation?

A

-drug-induced (amiodarone, sotalol, macrolides, SSRI, TCA, antifungals, haloperidol)
-hypokalaemia
-severe bradycardia

38
Q

What is tx for QT prolongation?

A

-IV magnesium sulphate
-Blocker x sotalol
-Consider atrial/ventricular pacing

39
Q

What is anti-arrhythmic drugs classified into?

A

Supraventricular arrythmias
ventricular arrythmias or both

40
Q

What is the electrical classification of anti-arrhythmic drugs?

A

less clinical
1) membrane stabilising drugs flecainide/lidocaine
2) bblockers
3) amiodarone, sotalol
4) CCB verapamil, diltiazem

41
Q

What is the dose of amiodarone ?

A

200mg TDS 7DY* 200mg BD 7DY* 200mg OD DIR

42
Q

When do you avoid amiodarone?

A

in bradycardia and heartblock

43
Q

What is the S/E of amiodarone?

A
  • corneal microdeposits (reversible if tx stopped)
  • thyroid disorders - hyper/hypo due to iodine
  • photosensitivity - avoid sunlight
  • hepatoxicity - liver disease
  • pulmonary toxicity - SoB, cough
  • vision impaired - blurry
44
Q

Interactions of amiodarone?

A
  • drugs that cause hyperkalaemia
  • drugs that cause QT prolongation
  • CYP450 enzyme inhibitors/inducers
  • drugs that cause bradycardia
45
Q

Monitoring for amiodarone?
Including IV route

A
  • Thyroid functions before * 6MT
  • LFT “ “
  • Chest x-ray before tx
    -annual eye exams
  • IV route : ECG + liver transaminase
46
Q

Which drugs need to monitored after stopping amiodarone?

A

for heartblock
Sofosburvir, daciatosuvir, simeprevir, sofosbuvir, lediapruvir

47
Q

What is maintenance dose for digoxin for AF?

A

125-250mcg
Different bioavailabilites for diff formulations

48
Q

what is therapeutic range for digoxin

A

0.7 to 2.0ng/ml

49
Q

What is the toxicity range for digoxin

A

1.5 - 3.0ng/ml

50
Q

What are the signs of toxicity for digoxin?

A

SICK + SLOW
- SA/AV block + bradycardia
- diarrhoea + vomiting
- dizziness, confusion, depression
- blurred/yellow vision

51
Q

Monitoring for digoxin?

A

-serum electrolytes + renal function
-take blood samples 6-12hr after each dose

52
Q

Digoxin interactions?

A
  • bblockers - inc risk of AV block + inc plasma conc
  • tricyclic antidepressants - induce arrythmias
  • drugs that cause hypokalaemia (inc digoxin toxicity)
  • cyp450 inducers (dec) + inhibtors (inc)

CDVD (10 decks)

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